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Evaluating antidote utilization as part of NOAC therapy

Use of the new antidote agents will be an institution-based decision, and clinicians will need to discuss how to add in and modify current institutional guidelines for reversing anticoagulants. Institutions and clinicians will also need to address how to handle the complicated trauma-bleeding patient; balance the need for stopping bleeding versus maintaining necessary anticoagulation. Various scenarios such as these will need to be evaluated, along with the use of concentrated clotting factors with the new antidotes. The issue of cost also is yet to be seen, as a prohibitively expensive therapy will lead to caution on widespread use. Outcomes will also be important-if the antidotes don't drive complications they will be more readily used.

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